Department of Pain Management, Tianjin First Central Hospital, 300192 Tianjin, China.
Jt Dis Relat Surg. 2022;33(3):513-520. doi: 10.52312/jdrs.2022.761. Epub 2022 Oct 21.
This study aims to compare the clinical effectiveness of transforaminal endoscopic spine system (TESSYS) technique combined with selective nerve root block (SNRB) in treating patients with far lateral lumbar disc herniation (FLDH) and patients with central or paracentral herniation (C/PDH).
Between June 2015 and June 2019, a total of 204 patients (80 males, 124 females; mean age: 62.3±5.4 years; range, 51 to 66 years) with a herniated disc were included. Of these, 22 consecutive adult patients with FLDH formed the FLDH group, while 182 patients with C/PDH formed the C/PDH group. Considering that FLDH was a rare type of LDH and occurred outside the spinal canal, the patients with LDH in the spinal canal (C/PDH) were selected as the controls in our study. All cases received ultrasound-guided SNRB to identify the diseased disc and treated by the TESSYS technique. Data including demographics, duration of operation, duration of hospital stay, surgical cost, complications, Visual Analog Scale (VAS) scores for the back and leg, and Oswestry Disability Index (ODI) scores and the modified MacNab criteria were analyzed.
The FLDH group presented the similar clinical outcomes and costs with the C/PDH group. No significant differences in the VAS score, ODI score, and Macnab score were observed between the groups (p>0.05 for all). Both groups showed the significantly improved postoperative VAS scores on Day 3, at 1, 3, 6, and 12 months compared to baseline. The postoperative ODI scores at 6 and 12 months were also significantly improved (p<0.05). At the final follow-up at 12 months, the FLDH group showed the MacNab criteria rating excellent and good of 81.8% and C/PDH group showed 84.62%.
The FLDH patients presented the comparable clinical effectiveness with C/PDH patients. Based on these findings, the TESSYS technique combined with ultrasound-guided SNRB for FLDH is safe and feasible with caution, although the risk of nerve root injury may be worried.
本研究旨在比较经皮椎间孔内镜脊柱系统（TESSYS）技术联合选择性神经根阻滞（SNRB）治疗极外侧腰椎间盘突出症（FLDH）和中央或旁中央型椎间盘突出症（C/PDH）患者的临床疗效。
2015 年 6 月至 2019 年 6 月，共纳入 204 例椎间盘突出症患者（男 80 例，女 124 例；平均年龄 62.3±5.4 岁；年龄 51 至 66 岁）。其中，22 例连续的成人 FLDH 患者为 FLDH 组，182 例 C/PDH 患者为 C/PDH 组。由于 FLDH 是一种罕见的腰椎间盘突出症类型，发生在椎管外，因此我们选择椎管内腰椎间盘突出症（C/PDH）患者作为对照组。所有患者均接受超声引导下 SNRB 以确定病变椎间盘，并采用 TESSYS 技术治疗。分析的临床资料包括一般资料、手术时间、住院时间、手术费用、并发症、腰背疼痛视觉模拟评分（VAS）、下肢疼痛 VAS 评分、Oswestry 功能障碍指数（ODI）评分和改良 MacNab 标准。
FLDH 组的临床疗效和费用与 C/PDH 组相似。两组间 VAS 评分、ODI 评分和 Macnab 评分差异均无统计学意义（p>0.05）。两组术后 3d、1 个月、3 个月、6 个月和 12 个月时的 VAS 评分均显著改善（p<0.05）。术后 6 个月和 12 个月的 ODI 评分也显著改善（p<0.05）。末次随访时（术后 12 个月），FLDH 组 MacNab 疗效评定优良率为 81.8%，C/PDH 组为 84.62%。
FLDH 患者的临床疗效与 C/PDH 患者相当。基于这些发现，TESSYS 技术联合超声引导下 SNRB 治疗 FLDH 是安全可行的，但需要注意神经根损伤的风险。
